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Neurogastroenterol Motil 2021 May 10:e14167. Epub 2021 May 10.

Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.

Background: Lidocaine is commonly applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (PM). We recently published data suggesting a benefit to this practice and we aimed to confirm these findings in a randomized trial.

Methods: We conducted a double-blind, randomized trial of lidocaine nasal spray versus placebo (saline) before EM and PM. Read More

West Afr J Med 2021 Apr;38(4):374-379

Department of Anaesthesiology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.

Background: Localization of epidural space has no clear-cut end point like during subarachnoid block, making it an enigma to the anaesthetist. Confirmation of correct placement of the catheter is desirable in order to prevent failure, high or total spinal when large amount of local anaesthetic agent is inadvertently injected in the intrathecal space, subdural block and lastly local anaesthesia systemic toxicity. This study evaluated the use of meniscus sign to confirm correct placement of epidural catheter. Read More

Pediatr Dent 2021 Mar;43(2):88-94

Dr. Divaris is a professor, Division of Pediatric and Public Health, Adams School of Dentistry, all at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.

Buffered local anesthetics offer an alternative to conventional, unbuffered anesthetic formulations; however, evidence about their use in children is scant. The purpose of this study was to determine the anesthetic and physiologic differences associated with the use of buffered one percent and unbuffered two percent lidocaine (both with 1:100,000 epinephrine) in children. In this randomized, double-blinded, crossover study, 25 children ages 10 to 12 years old received two inferior alveolar never blocks, at least one week apart, randomized to alternating sequences of two drug formulations: (1) formula A-three mL buffered one percent lidocaine (i. Read More

Otol Neurotol 2021 Apr 14. Epub 2021 Apr 14.

Tusker Medical, Inc., a subsidiary of Smith + Nephew, Menlo Park, California Ear Medical Group ENT Clinics of San Antonio, San Antonio, Texas.

Objective: To evaluate local and systemic safety of bilateral iontophoretic administration of lidocaine with epinephrine or lidocaine alone to the tympanic membrane (TM).

Study Design: A randomized, double-blind, two-arm study was conducted at a single center. Healthy adults were randomized to bilateral iontophoretic treatment with 2% lidocaine, 1:100,000 epinephrine, or 2% lidocaine (control). Read More

J Clin Med 2021 Feb 25;10(5). Epub 2021 Feb 25.

Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Neurotoxic effects of local anesthetics (LAs) on developing motor neurons have not been documented. We investigated the neurotoxic effects of LAs on developing motor neurons in terms of cell viability, cytotoxicity, reactive oxygen species (ROS), and apoptosis. Embryonic spinal cord motor neurons were isolated from Sprague-Dawley rat fetuses and exposed to one of the three LAs-lidocaine, bupivacaine, or ropivacaine-at concentrations of 1, 10, 100, or 1000 µM. Read More

Trials 2021 Feb 11;22(1):131. Epub 2021 Feb 11.

Hôpital de Hautepierre, Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

Objectives: The main objective of this study is to evaluate the effect of intravenous lidocaine on gas exchange and inflammation in acute respiratory distress syndrome due or not to Covid-19 pneumonia.

Trial Design: This is a prospective monocentric, randomized, quadruple-blinded and placebo-controlled superiority trial. This phase 3 clinical study is based on two parallel groups received either intravenous lidocaine 2% or intravenous NaCl 0. Read More

MedEdPORTAL 2021 01 28;17:11089. Epub 2021 Jan 28.

Associate Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital.

Introduction: Lidocaine is a common local anesthetic used during minor procedures performed on pediatric patients. A rare but toxic and life-threatening side effect of lidocaine is methemoglobinemia. It should be considered in children who are hypoxic after exposure to an oxidizing agent. Read More

Pharmaceutics 2021 Feb 1;13(2). Epub 2021 Feb 1.

Laboratory of Membrane and Liposome Research, Department of Biochemistry, IMRIC, The Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel.

We previously reported the development of a novel formulation of an ultra-long-acting local anesthetic based on bupivacaine encapsulated in large multivesicular liposomes (Bupisomes) embedded in hydrogel. This formulation (Bupigel) prolonged bupivacaine release from the formulation in dissolution-like studies in vitro and analgesia in vivo in mouse, rat, and pig models. In this study we assessed Bupigel neurotoxicity on rabbit sciatic nerve using histopathology and electrophysiologic testing. Read More

Drug Des Devel Ther 2021 14;15:195-207. Epub 2021 Jan 14.

Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, People's Republic of China.

Local anesthetics have the advantage of complete analgesia with fewer side effects compared to systemic analgesics. However, their clinical use is limited due to their short duration of action. Thus, local anesthetics with fast onset, long duration of action, selective nociceptive block, and low local and systemic toxicity are highly desirable. Read More

BMC Anesthesiol 2021 Jan 5;21(1). Epub 2021 Jan 5.

Department of Pediatric Anesthesiology and Intensive Care, Medical University of Warsaw University Clinical Centre, ul. Żwirki i Wigury 63A, 02-091, Warsaw, Poland.

Intravenous lidocaine, a potent local anesthetic with analgesic and anti-inflammatory properties, has been shown to be an effective adjunct that reduces intra- and postoperative opioid consumption and facilitates pain management in adults. While it shows promise for use in the pediatric population, limited evidence is available.

Objectives: To determine if general anesthesia with intraoperative intravenous lidocaine infusion versus general anesthesia without intravenous lidocaine infusion in children undergoing laparoscopic appendectomy decreased opioid requirements intra- and postoperatively. Read More

Brain Behav 2021 Feb 25;11(2):e01940. Epub 2020 Dec 25.

Laboratory of the Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil.

Introduction: Local anesthetics are widely used in clinical practice. While toxicity is rare, these drugs can cause potentially lethal seizures.

Objective: In the present study, we investigated the electrocorticographic (ECoG) and electromyographic patterns of seizures induced by acute lidocaine (LA) toxicity and treated with anticonvulsant drugs. Read More

Dent Res J (Isfahan) 2020 Sep-Oct;17(5):347-353. Epub 2020 Sep 7.

Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Higher Education and Research, Chennai, Tamil Nadu, India.

Background: Interaction between 2% lidocaine HCl (with and without adrenaline) and sodium hypochlorite (NaOCl) resulted in a toxic precipitate formation. The aim of this study was to assess the interaction between 4% articaine hydrochloride with adrenaline (AHa) and commonly used endodontic irrigants 3% NaOCl, 2% chlorhexidine (CHX), and 17% ethylenediaminetetraacetic acid (EDTA) using spectroscopic analyses.

Materials And Methods: In this study, 3% NaOCl, 2% CHX, and 17% EDTA were mixed with 4% AHa individually. Read More

J Cardiothorac Vasc Anesth 2021 Jun 25;35(6):1833-1838. Epub 2020 Nov 25.

Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA.

Regul Toxicol Pharmacol 2021 Feb 7;119:104838. Epub 2020 Dec 7.

Institute of Life Science, Swansea University Medical School, Singleton Park, Swansea, SA3 5DE, United Kingdom.

Lidocaine has not been associated with cancer in humans despite 8 decades of therapeutic use. Its metabolite, 2,6-xylidine, is a rat carcinogen, believed to induce genotoxicity via N-hydroxylation and DNA adduct formation, a non-threshold mechanism of action. To better understand this dichotomy, we review literature pertaining to metabolic activation and genotoxicity of 2,6-xylidine, identifying that it appears resistant to N-hydroxylation and instead metabolises almost exclusively to DMAP (an aminophenol). Read More

Arch Toxicol 2021 01 2;95(1):229-252. Epub 2020 Dec 2.

NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany.

Prediction of drug toxicity on the human nervous system still relies mainly on animal experiments. Here, we developed an alternative system allowing assessment of complex signaling in both individual human neurons and on the network level. The LUHMES cultures used for our approach can be cultured in 384-well plates with high reproducibility. Read More

Toxicol Lett 2021 Mar 27;338:114-127. Epub 2020 Nov 27.

European Food Safety Authority, Scientific Committee and Emerging Risks Unit, Via Carlo Magno, 1A, 43126 Parma, Italy. Electronic address:

In animal health risk assessment, hazard characterisation of feed additives has been often using the default uncertainty factor (UF) of 100 to translate a no-observed-adverse-effect level in test species (rat, mouse, dog, rabbit) to a 'safe' level of chronic exposure in farm and companion animal species. Historically, both 10-fold factors have been further divided to include chemical-specific data in both dimensions when available. For cats (Felis Sylvestris catus), an extra default UF of 5 is applied due to the species' deficiency in particularly glucuronidation and glycine conjugation. Read More

J Cancer 2020 23;11(24):7312-7319. Epub 2020 Oct 23.

Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.

It has been reported that local anesthetics are toxic to various types of cells. Furthermore, several local anesthetics have been confirmed to exert demethylation effects and regulate the proliferation of human cancer cells. Our previous findings suggest that lidocaine may exert potential antitumor activity and enhance the sensitivity of cisplatin to hepatocellular carcinoma and . Read More

Pharmaceutics 2020 Nov 9;12(11). Epub 2020 Nov 9.

JUVIC Inc., No. 208, Digital-ro 272, Guro-gu, Seoul 08389, Korea.

Lidocaine is a local anesthetic agent used in the form of injection and topical cream. However, these formulation types have limitations of being either painful or slow-acting, thereby hindering effective and complete clinical performance of lidocaine. Dissolving microneedles (DMNs) are used to overcome these limitations owing to their fast onset time and minimally invasive administration methods. Read More

Toxicol Lett 2021 Jan 6;336:1-10. Epub 2020 Nov 6.

Department of Anesthesiology, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha City, Hunan Province, China. Electronic address:

Lidocaine induces neurotoxicity in the spinal cord, but the underlying mechanisms remain unclear. In this study, we evaluated the effects of miR-199a-5p on 10 % lidocaine neurotoxicity. Increased expression of miR-199a-5p in the spinal cord of rats treated with 10 % lidocaine was assessed by qRT-PCR. Read More

J Pain Res 2020 22;13:2329-2332. Epub 2020 Sep 22.

Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea.

Lidocaine is a cost-effective drug that is widely used for local and regional anesthesia. However, central nervous system (CNS) toxicity can occur when lidocaine is administered above the maximum recommended dose (approximately 4.5 mg/kg) or if lidocaine is injected intravascularly rather than administered locally. Read More

Vet Anaesth Analg 2021 Jan 15;48(1):134-141. Epub 2020 Sep 15.

Department of Veterinary Medicine and Surgery, Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brazil.

Objective: To evaluate the analgesic efficacy and safety of tumescent local anesthesia (TLA) in cats undergoing unilateral mastectomy.

Study Design: Prospective clinical trial.

Animals: A total of 12 ovariohysterectomized female cats. Read More

Mil Med 2021 02;186(3-4):e451-e453

Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health Sys tem, Richmond, VA, 23219, USA.

Clonidine is a central alpha-2 agonist well known to produce a syndrome of bradycardia and hypotension in overdose. However, few examples of overt clinical clonidine toxicity secondary to cutaneous absorption have been reported. We report a case of unintentional systemic clonidine toxicity in an adult because of a compounded preparation of clonidine applied to a degraded skin barrier. Read More

J Sep Sci 2020 Nov 26;43(22):4225-4233. Epub 2020 Oct 26.

Department of Biochemistry, Faculty of Science, Masaryk University, Brno, Czech Republic.

The effective concentration of a drug in the blood, i.e. the concentration of a free drug in the blood, is influenced by the strength of drug binding onto plasma proteins. Read More

Int J Biol Macromol 2020 Dec 12;164:4591-4602. Epub 2020 Sep 12.

Akdeniz University, Faculty of Science, Department of Chemistry, Antalya, Turkey. Electronic address:

In this study, agar/κ-carrageenan/montmorillonite (MMT) hydrogels were prepared to examine their usability as wound dressing materials and to see the effect of MMT amount on some properties of agar/κ-carrageenan hydrogel materials. Hydrogels were characterized by SEM-EDX, TEM and DSC analyses. By increasing the MMT content within hydrogel matrix from 0% to 5%, the decomposition temperature of the hydrogel material was increased from 256. Read More

Anesthesiology 2020 11;133(5):1077-1092

Background: Local anesthetics, particularly potent long acting ones such as bupivacaine, can cause cardiotoxicity by inhibiting sodium ion channels; however, the impact of left ventricular hypertrophy on the cardiotoxicity and the underlying mechanisms remain undetermined. Transient receptor potential canonical (TRPC) channels are upregulated in left ventricular hypertrophy. Some transient receptor potential channel subtypes have been reported to pass relatively large cations, including protonated local anesthetics; this is known as the "pore phenomenon. Read More

Toxicol Res (Camb) 2020 Jul 17;9(4):467-473. Epub 2020 Jul 17.

Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province P. R. China.

Lidocaine is one of the most common local anesthetics (LA) used in clinical practice and it is neurotoxic. Recent studies suggested that LA, including lidocaine, could exert protective effect over neurotoxicity by promoting autophagy. However, the underlying mechanism was not sufficiently elucidated. Read More

Reg Anesth Pain Med 2021 Jan 31;46(1):86-89. Epub 2020 Aug 31.

UOC Anesthesia and Intensiva Care Unit, Padua University Hospital, Padova, Italy.

Introduction: Erector spinae plane (ESP) block is an emerging interfascial block with a wide range of indications for perioperative analgesia and chronic pain treatment. Recent studies have focused their attention on mechanisms of action of ESP block. However, the pharmacokinetics of drugs injected in ESP is, as of now, uninvestigated. Read More

J Med Syst 2020 Aug 13;44(9):169. Epub 2020 Aug 13.

Department of Anesthesiology, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington, VT, USA.

Medications administered by anesthesia health care providers and subsequently excreted into the water supply system have the potential to affect ecological systems. Presently, there is a lack of literature examining which medications or metabolites enter the waste stream. Further, their potential environmental impacts are often unknown or simply not considered as an externality of medical practice. Read More

Am J Phys Med Rehabil 2021 01;100(1):82-91

From the Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota (EK, MS, JS, WQ); Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota (EK, MS, CG-G, MLG, SJ, AJvW); Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, Minnesota (MS, CG-G, SJ, AJvW); Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China (MS); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (ABD).

Purpose: We evaluated biological effects of distinct local anesthetics on human adipose-derived mesenchymal stem cells when applied to reduce periprocedural pain during mesenchymal stem cell injections.

Methods And Materials: Metabolic activity (MTS assay), viability (Live/Dead stain), and gene expression (quantitative real-time reverse-transcriptase polymerase chain reaction) were measured in mesenchymal stem cells incubated with various concentrations of lidocaine, ropivacaine, or bupivacaine during a 12-hr time course.

Results: Cell viability and metabolic activity decreased in a dose, time, and substance-specific manner after exposure to lidocaine, ropivacaine, and bupivacaine, with ropivacaine being the least cytotoxic. Read More

Drugs Real World Outcomes 2020 Sep;7(3):205-212

Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, B309, Ottawa, ON, K1Y 4E9, Canada.

Background: In the perioperative period, intravenous lidocaine has been used as an opioid-sparing systemic analgesic with additional anti-inflammatory and anti-hyperalgesic properties.

Objective: The aim of this retrospective study was to review the utilization, efficacy, and safety of intravenous lidocaine on our Acute Pain Service (APS) and identify surgical and patient populations where this intervention was found to be useful.

Patients And Methods: This retrospective study was designed to assess acute pain management in patients who received an intravenous lidocaine infusion between February 2013 and December 2017. Read More